人工晶状体材质和后表面形态对囊袋弯曲速度的影响

Effect of material and posterior surface curvature of intraocular lens on posterior capsule opacification

目的:客观评价晶状体材质、后表面形态对囊袋弯曲速度的影响。方法:非随机化临床试验。根据植入人工晶状体的不同,将老年性白内障患者分为三组,A1-UV组15例15眼,AO组15例15眼,IQ组15例15眼。分别在术后1d,1、2、4wk,通过裂隙灯观察术眼的上、下、左、右四个方位囊袋与人工晶状体边缘贴合程度。结果:术后1d囊袋弯曲系数,A1-UV组为3.34±0.22,AO组为3.00±0.19,IQ组为3.45±0.42,三组的囊袋弯曲系数的差异有统计学意义(χ2=16.55,P<0.05)。对三组的临床疗效进行两两比较,发现A1-UV组和AO组的差异有统计学意义(χ2=12.02,P<0.05),A1-UV组和IQ组的差异无统计学意义(χ2=0.01,P>0.05),AO组和IQ组的差异有统计学意义(χ2=12.79,P<0.05)。术后1wk囊袋弯曲系数,A1-UV组为4.01±0.04,AO组为3.08±0.26,IQ组为3.50±0.44,三组的囊袋弯曲系数的差异有统计学意义(χ2=29.07,P<0.05)。对三组的临床疗效进行两两比较,发现A1-UV组和AO组的差异有统计学意义(χ2=28.64,P<0.05),A1-UV组和IQ组的差异有统计学意义(χ2=10.53,P<0.05),AO组和IQ组的差异无统计学意义(χ2=4.44,P>0.05)。术后2wk囊袋弯曲系数,A1-UV组为4.04±0.08,AO组为3.15±0.32,IQ组为3.53±0.47,三组的囊袋弯曲系数的差异有统计学意义(χ2=27.49,P<0.05)。对三组的临床疗效进行两两比较,发现A1-UV组和AO组的差异有统计学意义(χ2=26.69,P<0.05),A1-UV组和IQ组的差异有统计学意义(χ2=11.28,P<0.05),AO组和IQ组的差异无统计学意义(χ2=3.27,P>0.05)。术后4wk囊袋弯曲系数,A1-UV组为4.04±0.08,AO组为3.16±0.36,IQ组为3.65±0.46,三组的囊袋弯曲系数的差异有统计学意义(χ2=25.14,P<0.05)。对三组的临床疗效进行两两比较,发现A1-UV组和AO组的差异有统计学意义(χ2=25.15,P<0.05),A1-UV组和IQ组的差异有统计学意义(χ2=7.11,P<0.05),AO组和IQ组的差异无统计学意义(χ2=5.52,P>0.05)。结论:囊袋弯曲速度受晶状体材质、后表面形态的共同影响。术后1d,影响囊袋弯曲速度的主要因素是人工晶状体的材质,疏水性丙烯酸酯人工晶状体可以加快囊袋弯曲速度。术后1~4wk,材质因素的影响减弱,影响囊袋弯曲速度的主要因素是人工晶状体的机械结构。具有高后凸形态的人工晶状体能够快速形成囊袋弯曲,加快囊袋与人工晶状体的黏附,减少晶状体上皮细胞向后囊迁移、增殖的时间,具有重要的临床应用价值。

AIM：To assess the effect of intraocular lens＇ material and posterior surface curvature on capsular bend speed.METHODS：A non-randomized clinical trial.According to the implanted intraocular lens（IOL）,senile cataract patients were divided into three groups,15 eyes in Proming^（） A1-UV group,15 eyes in Akreos（） AO group and 15 eyes in AcrySof（） IQ group.The adhesion degree between capsule and IOL optic edge in eyes was measured by slit lamp at 1d,1wk,2wk and 4wk after cataract surgery.RESULTS：At postoperative 1d,the Capsular Bend Indexs（CBIs） of A1-UV group,AO group,IQ group were3.34±0.22,3.00±0.19,3.45±0.42,respectively and the differences were statistically significant（χ~2=16.55,P〈0.05）.Pairwise comparison results showed that the difference between A1- UV group and AO group was statistically significant（χ~2 = 12.02,P〈0.05）.The difference between A1-UV group and IQ group was no statistically significant（χ~2=0.01,P〈0.05）.The difference between AO group and IQ group was statistically significant（χ~2=12.79,P〈0.05）.At postoperative 1wk,the CBIs of A1-UV group,AO group,IQ group were 4.01 ±0.04,3.08±0.26,3.50 ± 0.44,respectively and the differences were statistically significant（χ~2=29.07,P〈0.05）.Pairwise comparison results showed that the difference between A1-UV group and AO group was statistically significant（χ~2=28.64,P〈0.05）.The difference between A1-UV group and IQ group was statistically significant（χ~2= 10.53,P〈0.05）.The difference between AO group and IQ group was no statistically significant（χ~2= 4.44,P〈0.05）.At postoperative 2wk,the CBIs of A1-UV group,AO group,IQ group were 4.04 ± 0.08,3.15 ± 0.32,3.53 ± 0.47,respectively and the differences were statistically significant（χ~2=27.49,P〈0.05）.Pairwise comparison results showed that the difference between A1-UV group and AO group was statistically significant（χ~2 = 26.69,P〈0.05）.The difference between A1-UV group and IQ group was statistically significant（χ~2=11.28,P〈0.05）.The difference between AO group and IQ group was no statistically significant（χ~2=3.27,P〈0.05）.At postoperative 4wk,the CBIs of A1-UV group,AO group,IQ group were 4.04 ± 0.08,3.16 ± 0.36,3.65 ± 0.46,respectively and the differences were statistically significant（χ~2= 25.14,P〈0.05）.Pairwise comparison results showed that the difference between A1-UV group and AO group was statistically significant（χ~2=25.15,P〈0.05）.The difference between A1-UV group and IQ group was statistically significant（χ~2 = 7.11,P〈0.05）.The difference between AO group and IQ group was no statistically significant（χ~2=5.52,P〈0.05）.CONCLUSION：Capsular bend speed can be influenced by the combined action of lOL＇s material and posterior surface curvature.lOL＇s material significantly influences capsular bend speed at postoperative 1d.Hydrophobic acrylic IOL speeds up the capsular bend.At postoperative1-4wk,the main factor influencing the capsular bend speed is mechanical structure,with a weakening influence of material.IOL with high convex posterior surface can form capsule bend rapidly,expedite the procedure of the capsular adhesion toward the optic edge,and reduce the time of migration and proliferation of lens epithelial cells to the posterior capsule,which has important clinical application value.